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Central and peripheral distribution of corticotropin-releasing factor.

Corticotropin-releasing factor (CRF) is widely distributed in the central nervous system and is associated with nuclei and pathways that control the release of adrenocorticotropin and beta-endorphin from the pituitary, and others that mediate central and peripheral autonomic responses to stress. Major concentrations of CRF immunoreactive neurons have been described in the hypothalamus, parts of the limbic system, several nuclei of the basal forebrain and brain stem, and the cerebral cortex. Recent data on the distribution of CRF immunoreactive perikarya and fibers in the preoptic-septal area, the thalamus, and the spinal cord are reviewed. Outside the nervous system, CRF-like immunoreactivity has been shown to occur in endocrine cells of the pancreas and gastrointestinal system, and in the liver, pituitary, adrenal, lung, placenta, and several endocrine tumors. However, the chemical identity of this "peripheral CRF" has not been determined.

Animals↗

Descriptive profile of birth defects among livebirths in Singapore.

A case-control study of birth defects was carried out in Kandang Kerbau Hospital in Singapore for a three-year period from January 1986 until December 1988. This paper presents the descriptive profile of birth defects among livebirths seen in that hospital. Out of 44,842 livebirths, 678 babies were found to have birth defects, giving a prevalence of 15.13 per 1000 livebirths (95% CI 14.0-16.2). The musculoskeletal system was the most frequently affected system accounting for 161 cases with a prevalence of 3.59 per 1,000 livebirths (95% CI 3.06-4.19), followed by 111 cases with defects of the gastrointestinal system (2.47 per 1,000 livebirths 95% CI 2.04-2.98), 88 cases of chromosomal disorders (prevalence of 1.96 per 1,000 livebirths 95% CI 1.57-2.42), 78 cases with defects of the cardiovascular system (1.74 per 1,000 livebirths 95% CI 1.38-2.17), 73 cases with defects of the urogenital system (1.63 per 1,000 livebirths 95% CI 1.28-2.05), and 52 cases with defects of the central nervous system (1.16 per 1,000 livebirths 95% CI 0.87-1.52). The prevalence of cleft lip, cleft palate in isolation, and cleft lip and palate combined was 1.72 per 1,000 livebirths and the occurrence of Down's syndrome was 1 in 700 livebirths. When reviewed 6 weeks postpartum, the rate of false positives at birth was 4%. In a control group of 709 "normal" cases at birth, the rate of cases not detected at birth but detected at 6 week follow-up, false negatives was 0.84%.

Case-Control Studies↗

Relationship between the rate of appearance of oxprenolol in the systemic circulation and the location of an oxprenolol Oros 16/260 drug delivery system within the gastrointestinal tract as determined by scintigraphy.

1. The position in the gastrointestinal tract of an orally administered oxprenolol Oros drug delivery system labelled with technetium-99m DTPA was followed by gamma scintigraphy, and the corresponding plasma drug concentration-time profiles after oral and i.v. administration were used to relate pharmacokinetic and transit data. 2. Gastric emptying time (0.8 +/- 0.4 h, mean +/- s.d.), and the time to arrival in the colon (3.8 +/- 0.7 h) were reasonably consistent after administration of the Oros system to fasted subjects, as were the calculated small intestine transit times (3.0 +/- 0.7 h). As expected there were wide individual variations in colonic transit, so that recorded values for total transit ranged from 6 to 32 h (median, 24.7 h). 3. Absorption of oxprenolol occurred throughout the GI tract including the colon. Plasma drug concentration-time profiles and input functions (calculated by deconvolution) could be related to transit behaviour and in vitro release. Inflexions in the calculated rate of drug input when the Oros system was located in the colon corresponded with periods of stagnation at the hepatic and splenic flexures in two subjects and the ileocaecal junction in two others. The mechanism of these changes is unclear.

Adolescent↗

[Diffusion of helminth parasites of the digestive system and respiratory system in deer (Cervus elaphus) of the La Mandria Regional Park (Piedmont)].

A study was carried out on the diffusion of helminth parasites of liver, gastrointestinal system and bronchial system in 68 red deer (Cervus elaphus) from Regional Park "La Mandria" (Piedmont, Italy). The following species of nematodes were identified: Trichostrongylus axei, Spiculopteragia spiculoptera, Rinadia mathevossiani, Cooperia oncophora, Cooperia pectinata, Cooperia punctata, Cooperia zurnabada, Oesophagostomum venulosum, Dictyocaulus eckerti, Varestrongylus sagittatus. Studies on some nematodes, belonging to the genera Spiculopteragia and Ostertagia, are still in progress. A large diffusion of Fascioloides magna was also present (only two young specimens resulted negative).

Animals↗

The gastrointestinal mucosal immune system.

The mucosal immune system, consisting of lymphoid tissues associated with the lacrimal, salivary, gastrointestinal, respiratory and urogenital tracts and lactating breasts, quantitatively contains the majority of the lymphoid tissue of the body. There are a number of important features of the gastrointestinal mucosal immune system: the mucosal immune system contains specialized structures, such as the Peyer's patches, where immune responses are thought to be initiated; there is a pattern of relatively specific recirculation of lymphoid cells to the mucosa, known as mucosal homing; subsets of lymphoid cells, particularly IgA B cells and memory T cells, predominate at mucosal surfaces; and the predominant mucosal immunoglobulin, secretory IgA, is particularly well adapted to host defense at mucosal surfaces. These elements of the gastrointestinal mucosal immune system function together to generate an immune response which on the one hand protects the host from harmful pathogens, but on the other hand is tolerant of the ubiquitous dietary antigens and normal microbial flora.

B-Lymphocytes↗

Current therapy for Behçet's disease.

Classified among the vasculitides, the clinical spectrum of Behçet's disease (BD) ranges from a mild mucocutaneous disease to a life-threatening systemic vasculitis, characterized by remissions and recurrences. The major morbidity is recurrent eye inflammation that may lead to blindness, but severe central nervous system, gastrointestinal, or vascular involvement may occur and might be fatal. In contradistinction to most other vasculitides, the venous system is commonly affected in BD. The treatment of BD is usually symptomatic and palliative. This includes topical steroids for orogenital ulcers, nonsteroidal antiinflammatory agents for joint involvement, and colchicine as prophylaxis against disease flares (although evidence that colchicine prevents recurrences of oral and genital ulcers is restricted to female patients). Immunosuppressives and cytotoxic agents are used for more severe involvement, and thalidomide and interferon have attracted attention in recent years.

Adrenal Cortex Hormones↗

Geriatric drug therapy and healthcare utilization in the United kingdom.

OBJECTIVE: To describe the use of prescription drug therapy, especially polypharmacy, in an elderly general population; to relate that use to age, gender, and different types of healthcare utilization; and to investigate the influence of selection of different time windows on the result of the quantity as well as the categories of drugs used. METHODS: Data on a sample of 5000 patients aged 65-90 years in 1996 were derived from the General Practice Research Database (GPRD). The population covered by GPRD is broadly representative of the UK population treated in general practice. Drug use was assessed using 2 time windows - current use of individual drugs on a random day (index date) and 1 month following the index date. Healthcare utilization was analyzed by use of information on visits to general practitioners (GPs), hospitalizations, and referrals to specialists. RESULTS: Women used more drugs than men; however, the prevalence of polypharmacy, defined as concomitant use of > or =5 drugs, was similar in both genders. The most frequently used therapeutic groups were cardiovascular, central nervous, and gastrointestinal system drugs. Almost 80% of both women and men visited a GP at least once a year. Overall, women used more ambulatory care services and men were hospitalized more often. Use of random date compared with 1-month period resulted in a significant underestimation of the amount of drugs used for acute conditions and, consequently, the risk of polypharmacy. CONCLUSIONS: The overall results confirm the findings in earlier studies suggesting that the GPRD might be a useful tool in further studies on prescription drug use among elderly persons. More information on the appropriateness of drug use is needed to prevent overuse as well as underuse of medications among the elderly.

Age Factors↗

Gastrointestinal health. The role of pro- and pre-biotics in standard foods.

BACKGROUND: Diarrhoea is a common symptom of gastrointestinal illness, ranking among the 20 most frequent reasons for patient encounters in general practice in Australia. Children under 5 years of age are especially vulnerable to bacterial gastroenteritis such as infections with Campylobacter jejuni. Everyday diet, in particular the regular consumption of pro- and pre-biotics, can help with the maintenance of a healthy gastrointestinal system. OBJECTIVE: This article outlines the potential of 'everyday standard' food items such as cheese to promote healthy gastrointestinal microflora and to prevent gastrointestinal illness such as diarrhoea. DISCUSSION: Some common food items such as yoghurt, sauerkraut, garlic and cheese contain probiotics in the form of live lactic acid bacteria, and/or prebiotics in the form of fructans, a dietary fibre. Cheese contains both probiotic bacteria and the prebiotic dietary fibre inulin. The regular consumption of cheese has been associated with a reduction in the risk of Campylobacter enteritis.

Cheese↗

[Adverse drug reactions among hospitalized elderly patients. Prospective study].

BACKGROUND: It is not clear if old age is a risk factor for adverse drug reactions. AIM: To study the incidence of adverse drug reactions and the effect of age in patients admitted to an Internal Medicine Service in an university hospital. PATIENTS AND METHODS: Two hundred one patients, hospitalized at the Clinical Hospital of the Catholic University, were studied. These patients were followed using a prospective pharmacological surveillance method. For statistical purposes, patients aged 65 years old or older were compared with those younger than 65 years old. RESULTS: Patients over 65 years old had a 33% incidence of adverse drug reactions, mainly involving cardiovascular system and provoking metabolic disturbances. Younger subjects had a 24% incidence of adverse drug reactions, mainly involving the gastrointestinal system and the skin. Sixteen percent of adverse drug reactions were classified as severe and there was a direct relationship between its frequency and the number of drugs prescribed, the hospitalization length and the presence of renal failure. Younger patients with adverse drug reactions had lower serum albumin levels than those without adverse reactions. This relationship was not observed in older patients. CONCLUSIONS: The frequency of adverse drug reactions in hospitalized patients, is related to the number of drugs prescribed and the length of hospitalization.

Age Factors↗

Sudden and unexpected death in horses and ponies: an analysis of 200 cases.

An analysis was made of the causes of death in horses and ponies over one year of age which died suddenly (Group 1) or were found dead but were considered normal when last seen (Group 2). There were 49 animals in Group 1. Thoroughbreds were overrepresented, but there were no ponies in this group. No cause of death was found in 30.6 per cent of cases and 16.3 per cent died from each of the following causes: haemorrhage in the respiratory system, central nervous system, and adverse drug reactions. Cardiovascular lesions were the cause of death in 14.4 per cent and the remaining 3.1 per cent had lesions of the gastrointestinal system. Racehorses mostly died suddenly from severe haemorrhage in various sites, particularly the thorax. In Group 2 there were 151 animals, and in 33.1 per cent no cause of death was determined. Gastrointestinal lesions were considered the cause of death in 39.2 per cent of cases and respiratory lesions killed 8.6 per cent. Lesions of both the central nervous system and cardiovascular system were considered the cause in 4.6 per cent of cases. The remaining 9.9 per cent of animals had miscellaneous lesions. Toxicological studies were performed in 46 of the total 200 cases, and only two had positive results; lead in one and nicotine in the other.

Age Factors↗

A computer-based gastrointestinal information management system.

A clinical data base system was developed that integrates gastrointestinal radiologic examinations, endoscopic studies, and pathologic diagnoses. An interrogative language is used, so that data input occurs by response to a series of relevant questions and answers that are constructed by the clinical staff without programmer support. Data are stored in a hierarchical, natural-language (noncoded) format, making them easily understandable by all clinical groups. Since the computer system is interactive, there are on-line capabilities for data input at various times as well as for instantaneous retrieval of all data on a given patient. Retrieval (search) of data uses Boolean logic, allowing for intercorrelative studies among radiology, endoscopy, and pathology. Data can then be isolated in files in which the computer can generate demographic and statistical data by use of a series of programs. Both data search and analysis can be accomplished without programming knowledge. Not only are research functions served by the system, but educational functions such as preparation of conferences and lectures, professional quality assurance, and resident teaching through follow-up and missed-case review can be performed.

Computers↗

Peripheral signals in the control of satiety and hunger.

PURPOSE OF REVIEW: Food intake is critical for survival and is a complex behavior with multiple levels of control. Short-term, meal-related signals arise from many sources including the gastrointestinal tract, the environment, and higher centers in the brain. As described in this review, inputs from the gastrointestinal tract can exert potent effects on meal initiation, meal termination, and meal frequency. The complex array of signals generated from the gastrointestinal system and from adipose tissue, which participate in the regulation of food intake, and specifically how these signals relate to satiety and hunger, is the focus of this review. RECENT FINDINGS: Literature on the role of the well-studied gastrointestinal peptide, cholecystokinin, in satiety, in addition to its interaction with long-term adiposity signals in mediating food intake will be reviewed. In addition, literature on the gastrointestinal hormones glucagon-like-peptide 1, apolipoprotein A-IV and peptide YY, and how they may act to regulate satiety, is described. Finally, the newly discovered hormone, ghrelin, and how it relates to meal initiation and hunger is discussed. SUMMARY: A better understanding of these systems and how they relate to body adiposity will prove to have important clinical applications. The available data suggest that interventions directed at multiple targets in the energy homeostasis system may be necessary to achieve and maintain weight loss.

Adipose Tissue↗

Lithium adverse reactions in psychiatric patients.

A brief review of the literature on the adverse reaction of lithium therapy in man is presented. This was aimed at both toxic and side effects of lithium on various organ systems of the body. Inconclusive, insufficient or conflicting data were found in several areas of possible lithium-induced toxicity, notably in lithium-associated nephrotoxicity. Results of prospective studies are needed to clarify this issue. Adverse reactions derived from continued administration of lithium salts with neuroleptic medications or with electroconvulsive therapy were also reviewed. Lithium-induced side effects on the endocrine and gastrointestinal systems were also summarized along with both dermatologic and ophthalmologic effects. The teratogenicity of lithium during pregnancy and its cardiovascular abnormalities were discussed. The target organs of lithium poisoning and their management were also presented.

Abnormalities, Drug-Induced↗

Is there need for change of health examinations for sea pilots?

Sea pilots must be capable of carrying out their work in all situations. Thus, they must not have any disease or defect, that could impair their job performance. By periodic medical examinations attempts are made to ensure their working capacity. In most countries these examinations are carried out by a general practitioner and they include only few if any objective laboratory tests. The aim of the present investigation was to study the effectiveness of the periodic medical examinations to find out in the population of pilots examined persons with health risks, especially risks for cardiovascular diseases. All the pilots examined were over 45 years old (n = 135, response rate 88%). Self-evaluation of health was carried out by a questionnaire. Blood analyses were made and chest X-ray as well as exercise-ECC were taken. The most common subjective symptoms concerned musculoskeletal and gastrointestinal systems; sleep disturbances were also quite common. The three most frequent diseases diagnosed earlier by a doctor were musculoskeletal and gastrointestinal diseases, and arterial hypertension. About 24% of pilots had a lower physical working capacity than predicted. The body mass index indicated at least 11% overweight in half of the cases. At exercise-ECG four pilots appeared to have an ischaemic heart disease and additionally eleven pilots had abnormal ECG. Over 80% of pilots had a serum cholesterol value higher than 5 mmol/l, and serum triglyceride values exceeded the normal value of 2.0 mmol/l in every fourth case. Serum glutamyl transaminase was pathological in over 20% of the cases, and serum glucose level in 8%. The findings by routine physical examinations were very few consisting of stiffness in musculoskeletal system, two cases of elevated blood pressure, two heart murmurs, varicose veins etc. In two cases an inguinal hernia was suspected. The current periodic health examinations does not seem to effectively prevent a person with possible health defect from working as a sea pilot. More objective tests must be included in these examinations and more attention should be paid to prevention of overweight, effective treatment of musculoskeletal symptoms, improving physical working capacity and helping pilots to manage their psychic stress.

Body Mass Index↗

Noninvasive imaging of the gastrointestinal tract.

Numerous radiographic and scintigraphic imaging modalities are now available for evaluating the gastrointestinal system. With a well-formulated plan based on patient history, physical examination, and laboratory values, together with knowledge of patient preparation techniques and consultation, an efficient customized approach to gastrointestinal disease can be accomplished.

Barium Sulfate↗

Endocannabinoid overactivity and intestinal inflammation.

Cannabinoid receptors of type 1 and 2 (CB(1) and CB(2)), endogenous ligands that activate them (endocannabinoids), and mechanisms for endocannabinoid biosynthesis and inactivation have been identified in the gastrointestinal system. Activation of CB(1 )receptors by endocannabinoids produces relaxation of the lower oesophageal sphincter and inhibition of gastric acid secretion, intestinal motility, and fluid stimulated secretion. However, stimulation of cannabinoid receptors impacts on gastrointestinal functions in several other ways. Recent data indicate that the endocannabinoid system in the small intestine and colon becomes over stimulated during inflammation in both animal models and human inflammatory disorders. The pathological significance of this "endocannabinoid overactivity" and its possible exploitation for therapeutic purposes are discussed here.

Cannabinoid Receptor Modulators↗

Effects of exposure to heavy particles on a behavior mediated by the dopaminergic system.

The effects of exposure to heavy particles on behaviors mediated by the central nervous system (CNS) are qualitatively different than the effects produced by exposure to other types of radiation. One behavior mediated by the CNS is the amphetamine-induced taste aversion, which is produced by pairing a novel tasting solution with injection of amphetamine. When the conditioning day is three days following irradiation, exposing rats to low doses of 56Fe particles (600 MeV/n or 1 GeV/n) eliminates the taste aversion produced by injection of amphetamine, which is dependent upon the integrity of the central dopaminergic system, but has no effect on the aversion produced by injection of lithium chloride which is mediated by the gastrointestinal system. In contrast to the effects obtained using heavy particles, exposing rats to 60CO gamma rays or to fission spectrum neutrons has no selective effect upon the acquisition of either amphetamine- or lithium chloride-induced taste aversions. When the conditioning day occurs four months following exposure to 1 GeV/n 56Fe particles, there is an enhancement of the amphetamine-induced taste aversion. The implications of these findings for approaches to risk assessment are considered.

Amphetamine↗

Oral glycopyrrolate alleviates drooling in a patient with tongue cancer.

Although sialorrhea and drooling are uncommon symptoms in cancer patients, they can cause considerable discomfort, inconvenience and social embarrassment. In this article we describe a patient with tongue cancer who was successfully treated with oral glycopyrrolate 0.4 mg 3 times daily. Glycopyrrolate is a quaternary ammonium compound. In contrast to the recommended treatment with scopolamine, glycopyrrolate is virtually without side effects to the central nervous system because it penetrates the blood-brain barrier poorly. Glycopyrrolate has a slow and erratic absorption from the gastrointestinal system, but even low plasma levels are associated with a distinct and long-lasting antisialogic effect.

Female↗